Special Prerequisites Of Palliative Care In Advanced Dementia
Originally, palliative care emerged in the UK for cancer patients in response to insufficient care for the terminally ill. Eventually conditions other than cancer were acknowledged as being in need of palliative care. Independent of specific diagnosis palliative care should be provided for people with life-threatening disease and their families âthrough the prevention and relief of suffering by means of early identification and impeccable assessment and treatment of pain and other problems, physical, psychosocial and spiritualâ to maintain or improve quality of life . Parallel to the development of palliative care dementia care developed separately both based on the same values for enhancing care of people with dementia and improving quality of life . Notably lessons learned from palliative care for people with cancer cannot simply be transferred to palliative care for people with dementia.
As dementia progresses people experience reduced or lost verbal communication abilities with a consequent impact on care. Despite restrictions in verbal communication people with advanced dementia can use other means of nonverbal communication such as body tension or minimal movements, turning their head away, frequency of breath and paralinguistic signals are all means of communication to express their current wishes or needs . Agreement or rejection reactions in a situation can be observed, although interpretation of nonverbal communication varies between health professionals .
What Is Alzheimers Disease
Alzheimers disease is a complex neurological condition marked by gradual loss of neuronal communication and higher mental functions that can adversely affect memory, speech, thinking, language, judgment, and behavior. It is the most common form of dementia that accounts for 60%-80% of all cases.
Alzheimers disease manifests initially with mild memory loss and lapses in judgment. As the disease gradually progresses, it can affect higher brain functions. In later stages, balance and coordination, as well as autonomic functions such as heart rate, breathing, digestion, and sleep cycles, are severely affected.
Variables Impacting Life Expectancy Calculations
Gender. Men dont live as long with Alzheimers as women. A study of more than 500 people diagnosed with Alzheimers disease between 1987 and 1996 found that women with Alzheimers live, on average, 20% longer than men. Age. Someone diagnosed at 65 lives an average of about eight years, while someone over 90 who gets a diagnosis typically lives about three-and-a-half more years. Strength of Symptoms at Diagnosis. If someone is showing especially severe dementia-related problems at the time of diagnosis, this usually leads to an earlier death. Someone who wanders, is prone to falling, and experiences urinary incontinence , will typically not live as long. A lower mini-mental state examination score at the time of diagnosis will also not live as long. Other Health Problems. A person with a history of heart problems or asthma or diabetes, for example, will not live as long as someone without those underlying issues.
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What Are Tau Tangles
Tau tangles or neurofibrillary tangles are clumps of a protein called tau and happen inside the neurons, inside brain nerve cells that are important for memory.
Tau protein is abundant in neurons and helps stabilize their axons. Thus, tau is important for normal neuron function.
During Alzheimers disease tau changes and clumps together, like the amyloid beta. But in this case the clumps happen inside the cells.
These clumps are called tangles because the tau protein looks like a helix similar to DNA but its a single helix. And these helices tangle up like a hairball.
What To Expect In The Late Stages Of Alzheimers Disease
What to Expect in the Late Stages of Alzheimers Disease
As Alzheimers advances into the later stages, caregivers and family members can expect quite a few new symptoms of the disease. Fortunately, being prepared now can help people better cope with the challenges of the late stages of Alzheimers.
Although the disease doesnt affect every person the same way, informed caregivers can often reduce later stage crisis. Read our list of the symptoms to expect in the late stages of Alzheimers to better prepare for tomorrow, today.
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Causes Of Death In People With Alzheimer’s Disease
Claudia Chaves, MD, is board-certified in cerebrovascular disease and neurology with a subspecialty certification in vascular neurology. She is an associate professor of neurology at Tufts Medical School and medical director of the Lahey Clinic Multiple Sclerosis Center in Lexington, Massachusetts.
The Alzheimer’s Association notes that Alzheimer’s disease is the sixth leading cause of death in the United States. It also points out that out of the top 10 causes of death, it’s the only one without an effective treatment or cure.
The Centers for Disease Control and Prevention also highlights Alzheimer’s as a significant cause of death, pointing out that between 1999 and 2014, deaths attributed to Alzheimer’s rose by 55%.
One of the challenges in tracking deaths from Alzheimer’s is that Alzheimer’s disease is not always identified as the cause of death on a death certificate. Sometimes, the conditions that develop from Alzheimer’s are listed instead as primary on the death certificate. In other cases, Alzheimer’s may have never been officially diagnosed. These challenges in tracking Alzheimer’s deaths are demonstrated in one study that found that deaths from Alzheimer’s in people over the age of 75 may be as high as six times the count officially recorded.
Stage : Mild Cognitive Impairment
Clear cognitive problems begin to manifest in stage 3. A few signs of stage 3 dementia include:
- Getting lost easily
- Noticeably poor performance at work
- Forgetting the names of family members and close friends
- Difficulty retaining information read in a book or passage
- Losing or misplacing important objects
- Difficulty concentrating
Patients often start to experience mild to moderate anxiety as these symptoms increasingly interfere with day to day life. Patients who may be in this stage of dementia are encouraged to have a clinical interview with a clinician for proper diagnosis.
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How Alzheimer’s Disease Is Treated
There’s currently no cure for Alzheimer’s disease, but medicines are available that can help relieve some of the symptoms.
Various other types of support are also available to help people with Alzheimer’s live as independently as possible, such as making changes to your home environment so it’s easier to move around and remember daily tasks.
Psychological treatments such as cognitive stimulation therapy may also be offered to help support your memory, problem solving skills and language ability.
Read more about treating Alzheimer’s disease.
When Do Dementia Patients Stop Eating
When a patient stops or refuses to eat, things can be very depressing for the caregiver. Drinking and eating are complex and have to do with a control center that is within the brain, which controls the muscles in the throat and neck area.
Dementia affects this part of the brain as it progresses and things like choking, coughing, grimacing as one swallows, clearing the throat, movements that are exaggerated, especially of the tongue and mouth, refusing to swallow, and spitting the food can be seen. This usually happens in the later stages of the disease.
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How Can I Support Someone With Dementia Towards The End Of Life
Knowing the person will make it easier to provide person-centred care that is focused on what they need and want. It can help to know about their likes, dislikes and their wishes for how they want to be cared for. If the person isnt able to tell you about themselves, speak to their family, friends or other people who know them well.
Its a good idea to find out if the person has a copy of This is me , a document that records information about themselves. If you cant speak to the person, ask those close to them if they have a copy. They may have these details recorded in their care plan.
There are many ways to support someone with dementia at the end of life.
How Hospice Can Help With End
In addition to helping you in recognizing the signs of dying in the elderly with dementia, bringing in hospice care will help with the physical and emotional demands of caregiving. Nurses will be able to adjust medication and care plans as the individuals needs change. Aides can help with bathing, grooming, and other personal care. Social workers can help organize resources for the patient and family. Chaplains and bereavement specials can help the family with any emotional or spiritual needs. Additionally, family members can contact hospice at any time, and do not need to wait until it is recommended by the patient’s physician.
To learn more about the criteria for hospice eligibility or to schedule a consultation, please contact Crossroads using the blue Help Center bar on this page for more information on how we can help provide support to individuals with dementia and their families.
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The Seven Stages Of Dementia
One of the most difficult things to hear about dementia is that, in most cases, dementia is irreversible and incurable. However, with an early diagnosis and proper care, the progression of some forms of dementia can be managed and slowed down. The cognitive decline that accompanies dementia conditions does not happen all at once – the progression of dementia can be divided into seven distinct, identifiable stages.
Learning about the stages of dementia can help with identifying signs and symptoms early on, as well as assisting sufferers and caretakers in knowing what to expect in further stages. The earlier dementia is diagnosed, the sooner treatment can start.
Provide Physical Comfort And Care
Assess the person to ensure they are not in discomfort or restless, and offer the kind of care described in the above section . Reduce any interventions to only what is necessary, for example change the persons position every few hours or when they need changing.
Give regular mouth care. This can be done hourly to prevent the persons mouth from becoming dry. Apply Vaseline to keep lips moist.
Give eye care, for example use a soft piece of wet clean gauze to prevent the persons eyes from looking sticky.
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What Are The Warning Signs Of Alzheimers Disease
Symptoms usually develop gradually and worsen over the years. Symptom progression varies from person to person and mostly manifests as forgetfulness in the initial stages.
One or more of the following symptoms may be present in someone with Alzheimer’s disease:
- Memory loss that disrupts daily life such as getting lost in a familiar place or repeating questions
- Inability to recognize familiar faces
- Trouble handling money and paying bills
- Difficulty completing basic tasks at home, work, or leisure
What Do Elderly People Think About Life And Death
As we get older, death seems to be nearer than when we are younger. In as much as anyone can die regardless of age, for an older person, it seems like it is more likely to happen, especially when dealing with different health conditions that the body does not handle as it used to in the younger years.
For older persons, death does not always spell sorrow and terror, as is the case with younger people. Many of the older people are contented with what the short-term future has for them. You may think that people may get anxious as they become older, but this is not the case. Older people do not have much sadness and anxiety, especially related to death. They are actually more positive about life and death.
As we grow older, our perspective shifts. This is when you realize that things are not as they always seem. Most people fear death because they feel that they will lose the things that they have been working so hard to get over the years. However, for older people, this attachment to things acquired is not really pronounced. This is how some of the fear of death actually melts away.
When you look around you and you realize that there are things that are a part of you that will outlive you actually help in a major way. This could be the legacy we have in children or gardens planted. There are yet others who place value on their country, their religion, or families that live on even after they are gone.
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Stage : Moderate Dementia
Patients in stage 5 need some assistance in order to carry out their daily lives. The main sign for stage 5 dementia is the inability to remember major details such as the name of a close family member or a home address. Patients may become disoriented about the time and place, have trouble making decisions, and forget basic information about themselves, such as a telephone number or address.
While moderate dementia can interfere with basic functioning, patients at this stage do not need assistance with basic functions such as using the bathroom or eating. Patients also still have the ability to remember their own names and generally the names of spouses and children.
Is Alzheimers A Terminal Illness
This question has a fair amount of subtlety. I have treated it at greater length HERE. But, suffice it to say that there are broad and narrow conceptions for what a âterminal illnessâ is.
On the broad conception, a terminal illness is merely one that reduces your life expectancy and that you will you will have at the time of your death. Alzheimerâs surely fits this general description.
On the narrow definition, a terminal illness is one that you are expected to die from very soon â maybe within twelve or twenty-four months. A person recently diagnosed with mild-cognitive impairment or early-stage Alzheimerâs may have eight to ten years to live. So, on this narrow definition, âAlzheimerâsâ â by itself â may not be a terminal illness. However, we could say that late-stage Alzheimerâs could plausibly be construed as a terminal illness. Because, by the time a person enters Alzheimerâs advanced, end, or late stage, it may well be that their life expectancy has been reduced to one or two years.
For a more in-depth discussion of this issue, click HERE.
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What Are The Early Signs Of Dementia
The onset of dementia is not obvious because the early signs can be vague and quite subtle. The early symptoms usually depend on the kind of dementia that one has and therefore can vary greatly from one person to the next.
Even though the signs can vary, there are some that are quite common and they include:
- Depression, apathy, and withdrawal
- Memory issues, especially when it comes to the most recent events
- Inability to handle the everyday tasks
At times, it is easy to miss to appreciate that the above symptoms could be an indication of something that is not right. Yet there are those who assume that the signs are normal and are associated with aging. It is also possible for one to develop the symptoms in a gradual manner and they may go unnoticed for quite some time.
People may not act even when they can tell that something is definitely wrong. It is important to have a checklist of all signs related to dementia and get the person the needed help when several of such signs are observed. It is important to get a more detailed assessment.
Memory loss and dementia: while it is normal to forget some things and remember later, persons with dementia tend to forget more frequently and they do not remember later.
Tasks: distractions can happen and you may forget to, say, serve one part of the family meal. For a person that has dementia, preparing the meal could be problematic and they may actually forget some of the steps that are involved.
Behavioral And Cognitive Symptoms Of Dementia
Michelle Niedens, L.S.C.S.W., in The Neuropsychiatric Symptoms of Alzheimers, states that 80% of individuals with dementia will experience neuropsychiatric symptoms.
Personality changes such as anxiety, depression or irritability are common in the early stages of the disease. Later, agitation, physical or verbal outbursts, pacing and restlessness are more common.
Behavioral symptoms have been identified as the most challenging and distressing for caregivers and family members. They are oftentimes the determining factor in deciding to move a family member with Alzheimers into a structured living environment.
Cognitive symptoms start out mild in the early stages of Alzheimers and gradually worsen as each stage progresses. In the late stages of Alzheimers, the person with the disease is no longer able to form new memories or access old ones. Language abilities become worse until the person is no longer able to communicate. Judgment and reasoning skills continue to diminish and eventually, the person with dementia loses the ability to reason altogether.
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Do Treatments Add Time To Life Expectancy
Experts simply dont know whether treatments help a person live longer with Alzheimers disease. AD and other similar dementias progress no matter what. Treatments like medications and therapies have been conclusively shown to help manage symptoms, meaning they make it easier to live with the disease, but they do not reverse symptoms. The memory of a person with dementia who takes medications like cholinesterase inhibitors, for example, will be slightly better than the memory of someone who is not on medication. Quality of life therefore improves with treatment. This means better years with dementia, but probably not more years.
Life Expectancy By Stage Of The Disease
The average number of years a person lives with Alzheimers disease is about 10. Keep in mind, however, that theres a gap between when symptoms begin and when a diagnosis is actually sought. The first symptoms of Alzheimers diseaseforgetting names, misplacing items, difficulty concentrating at work or performing simple tasksarrive an average of almost three years before the diagnosis is made.
The scale most commonly used by health professionals for the stages of dementia is the Global Deterioration Scale , also called the Reisberg Scale. The table below shows a patients average life expectancy by the stage of dementia. These are averages based on studies of large numbers of Alzheimers patients.
|Life Expectancy By Stage of Alzheimers / Dementia|
|Stage 7: Very Severe Cognitive Decline||1.5 to 2.5 years||2.5 years or less|
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